Differential Diagnosis for a 7-year-old Girl with Mild Eye Swelling and Cough
Single Most Likely Diagnosis
- Allergic Rhinitis: This is a common condition in children, often presenting with eye swelling, cough (due to postnasal drip), and can be associated with mild proteinuria due to systemic inflammation or allergic nephropathy. The symptoms of mild eye swelling for 5 days and a cough for 2 weeks align well with allergic rhinitis, especially during peak allergy seasons.
Other Likely Diagnoses
- Viral Upper Respiratory Infection: Many viruses can cause upper respiratory infections that lead to cough and eye swelling due to viral conjunctivitis or sinusitis. The presence of a cough for 2 weeks suggests a prolonged viral infection.
- Bacterial Sinusitis: This condition can cause cough, eye swelling (if the infection spreads to the surrounding tissues), and potentially mild urinary findings if there's associated systemic illness or dehydration affecting renal function.
- Nephrotic Syndrome: Although less common, nephrotic syndrome can present with edema (which might be perceived as eye swelling), proteinuria, and potentially a cough if there's associated pulmonary edema or infection. However, the edema in nephrotic syndrome is typically more generalized.
Do Not Miss Diagnoses
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): A rare autoimmune disorder that can cause respiratory and renal symptoms, including cough and proteinuria. Eye involvement can occur, making it a critical diagnosis not to miss due to its potential severity and need for aggressive treatment.
- Systemic Lupus Erythematosus (SLE): An autoimmune disease that can affect multiple systems, including the kidneys (causing proteinuria) and eyes (causing swelling or other ocular manifestations). It's essential to consider SLE due to its potential for severe complications if left untreated.
- Goodpasture Syndrome: An autoimmune disease that affects the lungs and kidneys, potentially causing cough and proteinuria. It's a rare but critical diagnosis due to its severity and the need for prompt treatment.
Rare Diagnoses
- Churg-Strauss Syndrome (Eosinophilic Granulomatosis with Polyangiitis, EGPA): A rare autoimmune condition characterized by asthma, eosinophilia, and vasculitis affecting various organs, including the lungs and kidneys. It could explain the cough and proteinuria but is less likely given its rarity.
- Tubulointerstitial Nephritis and Uveitis Syndrome (TINU): A rare condition that affects the kidneys and eyes, causing symptoms such as proteinuria and eye swelling. It's an important consideration in patients with unexplained renal and ocular findings.